Higenbottam T W, Butt A Y, Dinh-Xaun A T, Takao M, Cremona G, Akamine S
Department of Medicine and Pharmacology, School of Medicine, University of Sheffield, UK.
Heart. 1998 Feb;79(2):175-9. doi: 10.1136/hrt.79.2.175.
To compare prostacyclin with an analogue, iloprost, in treatment of severe pulmonary hypertension.
Eight patients with severe pulmonary hypertension: primary in five, thromboembolic pulmonary hypertension in three.
All patients underwent right heart catheterisation. Mean (SEM) right atrial pressure was 9.9 (2.2) mm Hg, mean pulmonary artery pressure 67.4 (3.0) mm Hg, cardiac index 1.75 (0.13) l/min/m2 and mixed venous oxygen saturation 59.1(3.1)%. Continuous intravenous epoprostenol (prostacyclin, PGI2) or iloprost was given for phase I (three to six weeks); the patients were then crossed over to receive the alternate drug in an equivalent phase II.
Exercise tolerance was measured at baseline and at the end of phase I and II with a 12 minute walk; distance covered, rest period, percentage drop in arterial oxygen saturation (delta Sao2%) and percentage rise in heart rate (delta HR%).
Walking distance covered rose from (mean (SEM)) 407.5 (73) to 591 (46) m with PGI2 (p = 0.004) and to 602.5 (60) m while on iloprost (p = 0.008). Rest period decreased from 192 (73) seconds at baseline to 16 (16) seconds with PGI2 (p = 0.01) and to 58 (34) seconds with iloprost (p = 0.008). Delta HR% was 37.5(6)% at baseline, 35(3)% on PGI2, and 24(6)% on iloprost (p = 0.04).
Both intravenous PGI2 and iloprost caused significant improvement in exercise tolerance. Iloprost offers an alternative to PGI2 treatment of severe pulmonary hypertension.
比较前列环素及其类似物伊洛前列素治疗重度肺动脉高压的效果。
8例重度肺动脉高压患者，其中原发性肺动脉高压5例，血栓栓塞性肺动脉高压3例。
所有患者均接受右心导管检查。平均（标准误）右心房压力为9.9（2.2）mmHg，平均肺动脉压力为67.4（3.0）mmHg，心脏指数为1.75（0.13）l/min/m²，混合静脉血氧饱和度为59.1（3.1）%。在第一阶段（3至6周）持续静脉输注依前列醇（前列环素，PGI2）或伊洛前列素；然后患者交叉接受另一药物进行为期相当的第二阶段治疗。
在基线时以及第一阶段和第二阶段结束时，通过12分钟步行试验测量运动耐量；测量步行距离、休息时间、动脉血氧饱和度下降百分比（ΔSao2%）和心率上升百分比（ΔHR%）。
使用PGI2时，步行距离从（平均（标准误））407.5（73）米增加到591（46）米（p = 0.004），使用伊洛前列素时增加到602.5（60）米（p = 0.008）。休息时间从基线时的192（73）秒减少到使用PGI2时的16（16）秒（p = 0.01），使用伊洛前列素时减少到58（34）秒（p = 0.008）。ΔHR%在基线时为37.5（6）%，使用PGI2时为35（3）%，使用伊洛前列素时为24（6）%（p = 0.04）。
静脉输注PGI2和伊洛前列素均能显著改善运动耐量。伊洛前列素为重度肺动脉高压的治疗提供了一种替代PGI2的选择。
